An inguinal hernia revealing an advanced stage gastric cancer in a young patient: A case report.
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ABSTRACT: Introduction
Gastric cancer (GC) is the fifth most common cancer and the fourth leading cause of death. It is much more common in advanced age and it is rare among the youngest patients (under 45 years of age).Case presentation
we report an unusual presentation of advanced gastric adenocarcinoma in 39-year-old man, who presented to our hospital with inguinal hernia without obvious gastrointestinal symptoms. He had strong family history of cancer, heavy smoking habit and weight loss. The intra-operative procedure identified a cyanotic separate spermatocele which was confirmed by the urologist. During investigation we found multiple liver metastasis in abdominal CT and advanced gastric adenocarcinoma from gastric biopsy and metastasis in spermatic cord sample and peritoneum sample of poorly differentiated adenocarcinoma.Conclusion
Although stomach adenocarcinoma is extremely rare in young patient but it should be kept in mind of physicians as a possible diagnosis if there are many risk factors.
SUBMITTER: Brimo Alsaman MZ
PROVIDER: S-EPMC9289344 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Giant inguinal hernia is unusual, and duodenal rupture accompanying it is particularly very rare and significantly hard to manage surgically.An 81-year-old man was admitted to our institution with upper abdominal pain. He had tenderness of the upper mid abdomen and a bilateral large inguinal hernia but he did not have pain in the inguinal-scrotal area. Computed tomography (CT) showed slight dilatation of the small bowel and stomach. There were no remarkable signs of incarceration of the inguinal hernia. Therefore, he was admitted to the internal ward. On the second day in hospital, he suddenly went into shock. CT revealed that there was free air and ascites in the inguinal hernia and therefore an emergency operation was performed. The tranverse colon, ascending colon, and ileum were incarcerated, and perfolation of the cecum was found. We also detected duodenal rupture at the inferior duodenal angle. We resected the terminal ileal (almost 90cm) and ileocecal area, followed by side-to-side anastomosis of duodenum and jejunum. We only repaired the peritoneum at the internal hernia ring. After the operation, despite intensive-care therapy, this patient passed away on the 18th postoperative day.The mesocolon and third portion of the duodenum were strongly pulled down into giant inguinal hernia, probably causing the rupture of the inferior duodenal angle.Giant inguinal hernia possibly provokes duodenal rupture and therefore should definitively be repaired if feasible.
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Project description:IntroductionOne of the most common surgical procedures performed annually is inguinal hernia repair. Inguinal hernias are traditionally known to be caused by a weakening in the abdominal wall and precipitated by increased intraabdominal pressure. Recently, intra-abdominal cancer producing the increased intraabdominal pressure, along with metastasis directly into the inguinal canal, have been identified in more studies as causes of inguinal hernias.Presentation of caseThis case focuses on a unique presentation of small-cell neuroendocrine carcinoma presenting as an inguinal hernia.DiscussionThis patient's rapid demise and advanced metastatic disease upon presentation is alarming, but his advanced disease process presenting as a routine inguinal hernia is noteworthy. Upon literature analysis, the number of advanced disease processes - most notably cancer - presenting as hernias is significant.ConclusionThis case emphasis the importance of perioperative screening, and presents the question, should hernias indicate further workup in the appropriate, at-risk patient populations.
| S-EPMC8082203 | biostudies-literature
Project description:IntroductionAnd importance: The most common postoperative complications after inguinal hernia repair are hernia recurrence, hematoma, seroma, wound infection, chronic pain, numbness and swelling. The aim of this case report is to present a rare complication of inguinal hernia repair, a large scrotal abscess that was caused by an inoculated scrotal hematoma 3 months after Transabdominal Preperitoneal bilateral inguinal hernia repair.Case presentationAn 84-year-old patient presented to the emergency department complaining about fever, pain and progressive swelling of the left hemiscrotum. He had undergone a Transabdominal Preperitoneal bilateral inguinal hernia repair 3 months earlier and a scrotal paracentesis 17 days earlier due to a scrotal hematoma. The pelvic CT scan was indicative of a large abscess in the left hemiscrotum compressing the ipsilateral testicle. Surgical exploration of the inguinal area was performed and considering the patient's advanced age the abscess was excised "en bloc" with the ischemic ipsilateral testicle. The patient had an uneventful recovery and was discharged home on the third postoperative day.Clinical discussionScrotal abscess, although rare, should be considered in the differential diagnosis of scrotal pain after inguinal hernioplasty. Scrotal drainage is sometimes used in order to relive the patient's discomfort caused by a swollen scrotum, but if not performed properly it can lead to serious infections. Postoperatively, a suction drain or elevation and compression of the scrotum may prevent scrotal complications.ConclusionScrotal abscess is a rare complication of inguinal hernioplasty. Scrotal care pathways establishment after inguinal hernia repair could help reduce and manage complications.
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Project description:IntroductionIncarcerated inguinal hernia is an irreducible but the blood supply to the contained part is intact, but developing towards strangulation. Diagnosis usually made by physical examination. The content of hernia sac may vary. The usual finding is a segment of small intestine and less commonly large intestine. Except in sliding hernia, the sigmoid colon is not common in inguinal hernia, especially on the right side.Case reportWe report a rare case of an incarcerated right side inguinal hernia containing the sigmoid colon of a 65-year old male, diagnosed with physical examination and abdominal ultrasonography. This patient treated by reducing the content of hernia sac and herniorraphy in general surgery ward of Aliabad Teaching Hospital.DiscussionInguinal hernia is the commonest of all groin hernia. Incarcerated inguinal hernia can lead to intestinal obstruction, strangulation and infarction. The content of inguinal hernia varies widely. In our case, the content of hernia sac was the incarcerated loop of sigmoid colon. The sigmoid colon is commonly found to herniate at the left inguinal region, but as a content of a right side inguinal hernia is rare.ConclusionThe sigmoid colon as a content of a right side inguinal hernia is rare. Mesh repair has always been a subject of debate due to increased risk of mesh infection rates. Many patients present complications due to delayed elective repair of inguinal hernia.
| S-EPMC9136348 | biostudies-literature
Project description:BackgroundSARS-Cov-2 infects not only adults, but also children, including pediatric surgery patients with acute abdomen. Here, we report a pediatric surgery case with incarcerated inguinal hernia and suspected COVID-19.Case presentationA 11-month-old male was brought to our emergency department with the main complaint of recurrent yellowish-green vomiting that was experienced from one day before admission. High fever and shortness of breath were also reported. This patient was also suffering from moderate dehydration. Neither history of contact with a confirmed case of COVID-19 nor traveling from any local transmission area were found. However, a SARS-CoV-2 rapid antibody test revealed a positive result. A lump in the left scrotum that persisted during admission was found. Fluid resuscitation and nasogastric tube placement for decompression was performed. Manual reduction was attempted but failed to reduce the lump. Accordingly, we decided to perform an emergency high ligation using tertiary protection regulations, i.e., full personal protective equipment (PPE) for COVID-19. Intraoperatively, we found a small intestine loop trapped in the scrotum and stuck in the inguinal canal. Postoperatively, the baby was continued to be managed as a patient with COVID-19 while waiting for the real-time reverse transcription polymerase chain reaction (RT-PCR) results.DiscussionManual reduction is standard treatment for incarcerated inguinal hernia in children. The successful rate of manual reduction is about 70%, therefore, if the manual reduction fails, an emergency surgery is mandatory.During the COVID-19 pandemic, all medical procedures require clarity of the patient's status including whether infected with COVID-19. Along with proper precautions, great care must be taken during surgery to minimize the risk of cross infection to health workers.ConclusionsDuring the COVID-19 pandemic, surgeons should always be aware of the possibility of cross-transmission from the patient, since children are also susceptible to SARS-CoV-2 infection. When and wherever possible, surgeons should perform the procedure in the quickest and most effective manner to shorten exposure time with patient and anesthetic aerosols as well as using appropriate PPE.
| S-EPMC7830290 | biostudies-literature
Project description:BackgroundHemangiopericytomas (HPC) are vascular tumors and can be found at any place where vessels are present. These were previously known as 'extrapleural Solitary Fibrous Tumour'. These tumors may reoccur and metastasize after surgical excision. We present herein a HPC of the greater omentum, diagnosed as left inguinal hernia preoperatively.Case presentationA 61-year-old male, presented with a huge painless mass in his left inguinoscrotal region secondary to weigh-lifting associated with malaise and vague abdominal pain. A well-defined, non-tender, and firm mass was found at the left lower abdomen extending to the left inguinoscrotal region. Based on the examination, a diagnosis of indirect inguinal hernia was made. Abdominal ultrasound showed a heterogeneous, hyporeflective, and vascularized mass. Contrast-enhanced computed tomography scan identified a localized, extraperitoneal, heterogeneously hypodense, well-defined, and lobulated mass, with marked contrast enhancement. On exploration, an encapsulated large mass originating from the omentum with enormously dilated blood vessels was excised. On histopathology, a neoplastic lesion, composed of spindle-shaped cells and moderate cytoplasm was identified. The blood vessels appeared thin-walled with a staghorn appearance in hemangiopericytic pattern. Omental sections showed fibro adipose tissue with dilated lymphatics and thick-walled blood vessels. Features were consistent with a malignant HPC of 20 × 14 × 10 cm.ConclusionWe present an unusual presentation of primary omental malignant HPC as an inguinal hernia, treated by complete surgical resection. These tumors are rare therefore, timely diagnosis is important for proper evaluation, diagnosis, and treatment. It also requires long-term follow up for better survival.
| S-EPMC7846890 | biostudies-literature
Project description:Internal hernias are a rare cause of acute intestinal obstruction. Supravesical hernia is an exceptional form of hernia that is often diagnosed intraoperatively. The abdominal CT scan performed in the emergency guides the preoperative diagnosis. Our work concerns a patient admitted to the visceral surgical department of the university hospital ibn Rochd of Casablanca for an occlusion dating back to 05 days, the abdmonial x-ray objectified hydro-aerial levels in the small intestine, and the CT scan found an invagination at the left fossa iliaca associated with a double hernia: internal supravesical and left inguinal. The patient was then operated after conditioning and the diagnosis of an internal supravesical hernia was retained per operatively. Internal supravesical hernia is a very rare cause of acute intestinal occlusion and is often diagnosed at the time of surgical exploration.
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Project description:BackgroundMorgagni's hernia (MH) is a rare type of congenital diaphragmatic hernia with limited available literature. Late presentations are infrequent and the ones complicated due to gastric volvulus are even rarer. Another uncommon association of MH is with small bowel diverticulosis. We herein discussed a case of gastric volvulus as the content of MH, and small bowel diverticulosis present in a patient concomitantly.Case presentationA 30 year old woman, who presented with a one year history of epigastric burning and indigestion, occasionally associated with pain and vomiting. On clinical examination, no clue to the diagnosis could be ascertained. Her chest and abdominal x-ray indicated an abnormal air-fluid level at right hemithorax, which prompted a Computed Tomography (CT) scan, showing organo-axial gastric volvulus. MH with gastric volvulus was observed during laparotomy and trans-thoracic reduction of the contents was performed, along with repair of the defect. Multiple intestinal diverticuli were also found and the largest diverticulum was excised.ConclusionsGastric volvulus through MH is a rare but potentially life-threatening condition. Non-specific symptoms like epigastric pain and vomiting can delay the diagnosis and management, however, advanced imaging techniques like CT scan can speed up this process. After the diagnosis is made, surgical repair should be attempted regardless of symptoms.
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Project description:Well-differentiated liposarcoma arising from the paratesticular region is rare, with only a few hundred cases reported in the literature. Due to their unexpected location, these tumors are often confused for common pathologies found in the groin, including inguinal hernia, seroma, or lymphoma. Standardized diagnostic and treatment pathways have not been established for patients with paratesticular liposarcoma, thereby elevating the importance of sharing our experience. This case describes the presentation of a 65-year-old man with a well-differentiated liposarcoma of the spermatic cord. Diagnosis was made after he underwent open herniorrhaphy to repair what was presumed to be a recurrent left inguinal hernia. Although a recommendation for formal oncologic resection and orchiectomy was made, the patient elected to proceed with watchful waiting and remains well up to last known contact. Paratesticular liposarcoma remains a rare clinical entity. While a few hundred cases have been reported in the literature, only a handful describe its presentation masked as an early recurrence of a groin hernia. Wide local resection along with orchiectomy and potential radiation therapy have been the mainstay of treatment. Clinicians should maintain a healthy level of suspicion for this uncommon pathology, especially in cases where patients present with early recurrence of an inguinal hernia.
| S-EPMC11292085 | biostudies-literature
Project description:IntroductionInguinal bladder hernia (IBH) is a rare condition representing less than 5% of all inguinal hernias. Most cases occur in elderly overweight men. Patients may present with variable symptoms such as urinary symptoms, inguinal swelling, or pain; however, most of them are asymptomatic and only less than 7% are diagnosed pre-operatively. Different radiological studies can be used if IBH suspected preoperatively including ultrasound, computed tomography scan; however, cystography is the most sensitive test for diagnosis of IBH. Open reduction and hernia repair are the standard treatment of IBH.Case presentationWe report a rare case of an-83-year-old male who presented with left inguinal pain associated with lower urinary tract symptoms including dysuria, nocturia, post-voidal dribbling, and urinary frequency. Laboratory studies showed acute kidney injury (AKI), and computed tomography (CT) of abdomen and pelvis without contrast CT revealed a herniation of 80% of the bladder through the left inguinal canal into the left scrotal sac, with moderate bilateral hydronephrosis and hydroureter, though no obstructing calculi are seen. Pre-operative diagnosis of incarcerated inguinal bladder hernia (IBH) was made, and a timely surgical intervention preceded by bladder catheterization led to a significant improvement of AKI and an excellent outcome without post-operative complications.Discussion and conclusionIBH is uncommon condition that can present with non-specific urinary symptoms; therefore, high index of suspicion is mandated for diagnosis especially in patients with risk factors. Pre-operative radiological evaluation to avoid iatrogenic bladder injury with subsequent surgical repair is the standard management for IBH as we accomplished in our case.
| S-EPMC7548979 | biostudies-literature